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Minimally Invasive Coronary Artery Bypass Surgery- A Single Surgeon Series of 335 Patients
Mohammed R. Sayeed, DNB( CTh) FRCSEd, MD1, Vivek Jawali2, Dharmesh Agrawal2, Murali Chakravorthy2, TA Patil2.
1Cardiovascular & thoracic surgery, Fortis Hospitals, Bangalore, India, 2Fortis Hospitals, Bangalore, India.
OBJECTIVE:
Many approaches for minimally invasive off-pump coronary artery bypass grafting (CABG) have gained widespread interest in the last decade. To expand the indications for MIDCAB from single-vessel disease to multi-vessel disease, we have used a partial inferior sternotomy which decreases the invasiveness by avoiding splitting of the manubrium sternii and preservation of the stability of the superior thoracic aperture which is the main factor of chest stability. The purpose of this study was to demonstrate the feasibility and safety of this technique.
METHODS:
Between March 2007 till date, a total of 335 patients, 226 males and 109 females with age ranging from 32 to 86 years, underwent OPCABG through a lower midline skin incision from the fourth intercostal space to the xiphoid process with longitudinal division of the lower half sternum up to the 3rd rib, with a reversed-J shaped division of the sternum. 73 patients(21.79%) had total arterial revascularization ; LIMA and RIMA in 32 patients, LIMA and Lt Radial Artery(Y graft) in 41 patients. 15 patients(4.47%) had critical left main stem disease, 47(14.02%) had single vessel disease, 63(18.8 %) had double vessel disease and the rest 225(67.16%) had triple vessel disease.
RESULTS:
The mean length of the skin incision was 6 cms. The mean number of grafts per patient was 3.3 (range 1 to 5). Average ICU stay was 12 hours with average ventilator time of 2.25 hours. Average 24 hour drainage was 370ml. Rate of blood transfusion was extrememly low. Average length of stay in hospital was 4 days. There were 2 conversions to full sternotomy. No major wound complications were seen. Postoperative pain score was 5. Five LIMA’s were damaged during harvest, 1 hospital death due to graft failure was observed.
CONCLUSIONS:
Our experience demonstrates that the partial inferior sternotomy approach is technically feasible for revascularizing multi-vessel disease in this era of minimally invasive surgeries with excellent cosmetic results and safety. Hence we conclude that this minimally invasive surgical technique can be used as an approach for multi-vessel beating heart surgeries.
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